No abstract

BackgroundManagement of catheter related infections (CRIs) depends on the severity, type of catheter and need to keep it. When it is documented, systemic antimicrobial therapy should be started, as antibiotics lock therapy if the central venous catheter (CVC) is not removed. We reviewed the management of CRIs in patients undergoing haemodialysis over 2 years and found that only 18.7% of patients were properly handled. We decided to develop a treatment protocol for this type of infections with the nephrology department.PurposeTo analyse changes in the management of CRIs in patients undergoing haemodialysis after implantation of a management protocol.Material and methodsAn observational and retrospective study was carried out over 6 months in patients undergoing haemodialysis in which intravenous antibiotic therapy was initiated after implementation of a CRI management protocol. The results were compared with the results obtained in a previous study on the implementation of this protocol. The following variables were recorded: sex, age, type of venous access, type of extracted sample (blood cultures, exudate catheter or other sample), microorganisms isolated, intravenous antibiotics used and antibiotic lock therapy in patients with CVC.Results24 requests for intravenous antibiotics for 18 patients were analysed. 66.6% were men, median age 68.9 years and 61.1% of patients had CVC. Blood culture samples were collected in 50% of patients and other samples obtained were urine culture (20.8%), wound exudates (20.8%) and catheter exit site exudates (12.5%). There was no catheter related bacteraemia because all blood cultures were negative. There were 10 positive results for the rest of the samples and Pseudomonas aeruginosa was the most common isolate (50%) followed by coagulase negative staphylococcus (20%). The most common treatment was vancomycin monotherapy (25%), followed by ceftazidime monotherapy (20.8%), a combination of both drugs (16.7%) and gentamicin (12.5%). Antibiotic lock therapy was performed in 70.8% of patients with CVC. Also, 12 pharmaceutical interventions about antibiotic selection, treatment duration or suspension because of negative results were made, and 66.7% were accepted.ConclusionResults have improved after implementation of a CRI management protocol, particularly antibiotic lock therapy (from 18.7% to 70.8%), although it is still necessary to reinforce the need for taking blood cultures in serious infection to discard CRIs.No conflict of interest

BackgroundSome complications described with enteral nutrition (EN) administration are metabolic and electrolyte disturbances.PurposeTo review glycaemic, renal and electrolyte alterations in patients receiving EN as exclusive diet.Material and methodsAll patients admitted except those hospitalised in the Intensive Care Unit who received EN during the study period (January to March 2017) were retrospectively reviewed using the Farmatools prescription program. Only those who covered at least 75% of their requirements (calculated using Harris Benedict equation and taking into account the stress factor) along this route and who received at least 5 days of EN were included.Variables registered, before beginning EN and after 5 days of treatment were: glycaemia, serum creatinine, serum sodium and potassium, and GOT and GPT values. Hyperglycaemia was considered as an increase with respect to baseline glucose of at least 20%, and altered creatinine as increase by at least 30%, both of them with a value above the recommended range.ResultsDuring the study period, 45 patients received EN and 21 (46.7%) covered 75% of their requirements. 57.1% were males and 42.9% females, with a mean age of 72.6 years.Of the total number of patients evaluated, five presented hyperglycaemia (8.9%), one hyperkalaemia (2.2%), two GOT elevation (4.4%) and four GPT elevations (8.8%). None of them presented creatinine value elevation.ConclusionIt is necessary to carry out a greater nutritional follow-up to patients admitted to our hospital who receive EN because half of them do not have their nutritional requirements covered. We have not detected significant alterations in the glycaemic, electrolytic and renal results, which is a reason why EN can be considered a safe type of nutritional support from the metabolic and electrolytic point of view.No conflict of interest

BackgroundPoor adherence to medical treatment represents a major issue in elderly population. It compromises the effectiveness of treatment making this a critical issue in population health.PurposeThe aims were to assess if the SMAQ questionnaire (SQ) is a reliable adherence measurement tool, to identify predictor factors of non-adherence and to investigate the relation between adherence and hospital readmissions in a cohort of patients.Material and methodsWe recruited patients aged >65 years, receiving polypharmacy (more than 4 drugs), in the trauma ward, from 1 April 2014 to 31 August 2015. Adherence was assessed with the SQ and a clinical interview (CI). A patient was considered adherent (AP) if adherence was verified both in the SQ and CI, and non-adherent (N-AP) as follows: SQ non-adherent patient (S-N-AP) when non-adherence was detected only in the SQ and CI non-adherent patient (CI-N-AP) if non-adherence was not detected in the SQ but was detected in the CI. Demographic, clinical variables and hospital readmissions over 3 months were collected. Statistical analysis was performed with the SPSS program: χ2 test for qualitative, ANOVA test for quantitative variables.Results245 patientst were enrolled. 213 (86.9%) completed the survey (SQ and CI). Mean age was 80.23 years (range 65–95). 25.3% were male and 61.6% female. The majority of diagnoses were hip (51.4%) and knee lesions (19.6%). 26.5% lived without caregiving. The main comorbidities were arterial hypertension (79.3%), 34.7% diabetes and 29.1% dislipidemia. 180 patients (84.5%) were AP and 33 (15.5%) were N-AP: 11 (5.2%) were S-N-AP and 22 (10.3%) were CI-N-AP. There were no factors significantly associated with medication adherence (sex, number of chronic drugs or comorbidities). Hospital readmissions were higher in N-AP (15.2% vs 7.8%) but the difference was not statistically significant.ConclusionNon-adherence is a real problem for older patients receiving polypharmacy. Interventions to target patient adherence should take this into account. No clear indicators of non-adherence were identified. Future researchers should consider other possible factors. The SQ alone, without other adherence measurements, is not an appropriate tool for this group of patients due to the fact that it failed to detect CI-N-AP, which represented 66.7% of N-AP.No conflict of interest.

BackgroundSince the clinical trial VIGOUR, in which the use of rofecoxib was proved to be connected to a larger number of cardiovascular accidents, an increase in cardiovascular diseases connected to the use of non-steroidal anti-inflammatory drugs has been observed.PurposeThis study intends to evaluate cardiovascular impact related to the use of non steroidal anti-inflammatory drugs.Material and methodsA retrospective observational study of a clinical cohort over 5 years was done in which all patients older than 18 years (n = 116 686) were included. The statistical analysis was done estimating the incidence of acute coronary syndrome in relation to exposure time. The risk associated with the consumption of non-steroidal anti-inflammatory drugs was made by Poisson regression adjusting for sex and age.ResultsThe connexion between acute coronary syndrome and the use of anti-inflammatory drugs was positive and significant (RR 3.64; 95% CI 2.94 to 4.52; p < 0.001). The cardiovascular risk was higher for alkanones (RR 18; 95% CI 2.53 to 127; p = 0.004), followed by propionoicos (RR 2.58; 95% CI 2.16 to 3.69; p < 0.001), arylacetic (RR 1.88; 95% CI 1.6 to 2.22; p < 0.001) and finally coxib (RR 1.55; 95% CI 1.25 to 1.92; p < 0.001); in other anti-inflammatories, no increased cardiovascular risk was observed.ConclusionThe use of non steroidal anti-inflammatory drugs has been connected to a higher risk of cardiovascular accidents; these drugs must not be consumed for a long time or at high doses.References and/or AcknowledgementsGarcía Rodríguez LA, González-Pérez A, et al. NSAID use selectively increases the risk of non-fatal myocardial infarction: a systematic review of randomised trials and observational studies. PLoS One 2011;6:e16780Varas-Lorenzo C, Castellsague J, et al. The use of selective cyclooxygenase-2 inhibitors and the risk of acute myocardial infarction in Saskatchewan, Canada. Pharmacoepidemiol Drug Saf 2009;18:1016-25García Rodríguez LA, Tacconelli S, Patrignani P. Role of dose potency in the prediction of risk of myocardial infarction associated with nonsteroidal anti-inflammatory drugs in the general population. J Am Coll Cardiol 2008;11(52):1628-36No conflict of interest.